title: Clock drawing in the Montreal Cognitive Assessment: recommendations for dementia assessment.
abstract: BACKGROUND
  Clock drawing is part of the Montreal Cognitive Assessment (MoCA) test but may have administration and scoring limitations. We assessed (1) the reliability of the MoCA clock criteria relative to a published error scoring approach, (2) whether command-only administration could distinguish dementia from cognitively intact individuals and (3) the value of adding a clock copy condition to the MoCA.
  
  
  METHODS
  Three novice raters and clocks from dementia and control participants were used to assess the 3 aims.
  
  
  RESULTS
  MoCA interrater and intrarater reliability were low (i.e. intraclass correlation coefficient = 0.12-0.31) and required repeat training. Clocks drawn to command classified dementia at chance. Inclusion of a copy condition demonstrated expected dementia subgroup patterns.
  
  
  CONCLUSIONS
  Reliable clock scoring with MoCA criteria requires practice. Supplementing a clock copy to the standard MoCA test (takes <1 min) will improve dementia assessment.
authors.affiliation: Department of Clinical and Health Psychology, University of Florida, 101 S. Newell Drive, Gainesville, FL 32610, USA. cep23@phhp.ufl.edu
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Price
authors.forename: Holly
authors.initials: H
authors.lastname: Cunningham
authors.forename: Nicole
authors.initials: N
authors.lastname: Coronado
authors.forename: Alana
authors.initials: A
authors.lastname: Freedland
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cosentino
authors.forename: Dana L
authors.initials: DL
authors.lastname: Penney
authors.forename: Alfio
authors.initials: A
authors.lastname: Penisi
authors.forename: Dawn
authors.initials: D
authors.lastname: Bowers
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
authors.forename: David J
authors.initials: DJ
authors.lastname: Libon
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002983:Clinical Competence; D003704:Dementia / Q000145:classification / Q000175:diagnosis* / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards*; D015588:Observer Variation; D011597:Psychomotor Performance; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity